MEDICARE: DR. JOSE EUGENIO RIVADENEIRA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22711	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376063313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE EUGENIO RIVADENEIRA DMD

Provider Business Mailing Address
First Line	:	8821 CHESTERTON PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10225 ULMERTON RD STE 1B
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-3522
Country	:	US
Telephone Number	:	727-223-4185
Fax Number	:	727-595-8189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	02/10/2026

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